Withdrawing life-prolonging medical treatment in 246 patients

Full text

Introduction

In this study, made in a 10-bed general ICU in a 500-bed district hospital, we examined 1) how often withdrawal (WD) decisions are made;, 2) the reasons and; 3) the results of the decisions.

Methods

We followed up medical charts of 246 patients in whom we had documented decisions to withdraw life-support, according to our written policy. The study period was between 1994-1998.

Results

The incidence of WD decisions was 7.7%. 41% of patients dying in the ICU, and 40% of those later dying in the ward, had a decision made of WD. Of the 246 patients with a WD decision, 57% died in ICU, 35% later in the general ward and 8% were discharged alive from hospital. Median age was 76 years in those with a WD decision, as compared with 64 years in those without a decision. Reasons for WD of therapy were autonomy in 6%, prognosis of acute disease in 34%, prognosis of coexisting, chronic disease in 19% and failure to respond to therapy in 41%. Median time from admission to ICU to WD was 2.8 days, and from decision to death in ICU 1.9 days. In four cases renewed consideration was done. We found one case of discordance with relatives concerning the WD decision.

Discussion

Our results were similar to Sjøqvist et al. in Sweden [2] and show that 1) these decisions are common (8%); 2) the reasons for the decision were mainly made from failure to respond to therapy and prognosis of the acute and underlying disease and; 3) few patients survive the hospital stay after such decisions.